Data Breach Notification Form send to California government


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Are you looking for an example Data Breach Notification Form to send to the Attorney General of the State of California for CCPA data breach?

The California Consumer Privacy Act (CCPA) is a sweeping change to existing privacy laws is an important change in data privacy regulations in the USA, as it aims to give Californian consumers broad rights to access and control their personal information. The bill (AB-375) was passed by the California State Legislature and signed into law by the Governor of California, on June 28, 2018, to amend Part 4 of Division 3 of the California Civil Code.

The CCPA applies to any business, including any for-profit entity that collects consumers' personal data, which does business in California, and satisfies at least one of these thresholds:
  • annual gross revenues in excess of $25 million;
  • possesses the personal information of 50K or more consumers, households, or devices; or
  • earns more than half of its annual revenue from selling consumers' personal data;
  • organizations are required to "implement and maintain reasonable security procedures and practices" in protecting consumer info.

Definition Personal Information according to the CCPA: 
Any information that identifies, relates to, describes, is capable of being associated with, or could reasonably be linked, directly or indirectly, with a particular consumer or household. Unique Examples: the real name, alias, postal address, unique personal identifier, online identifier, internet protocol (IP) address, email address, account name, social security number, driver's license number, passport number, search history, biometric data, geolocation or other similar identifiers.

The intentions of the Act are to provide California residents with the right to:
  • access their personal info;
  • prevent the sale of personal info;
  • know what personal info is being collected about them;
  • know whether their personal info is sold or disclosed and to whom;
  • request an organization to delete any personal data about a consumer collected from that consumer;
  • not be discriminated against for exercising their privacy rights.

Enforcement date: January 1, 2020, at which time those businesses in non-compliance may face civil fines between $2,500 and $7,500. Californian residents have the private right of action for data breaches, in case of failure is proven, there can be statutory damages between $100 and $750.

We're here to help you become compliant. The CCPA comes with a set of Rules and Regulations for the protection of personal data inside and outside the state of California and affects all businesses that save personal data from California residents. When a data breach occurs, you must notify the government of such a data breach and the impact it might have. This Data Breach Notification Form is an example CCPA document template you may use in such a situation. The document template comes as a Microsoft Office format and can be easily customized according to your company's specific needs.

Download this Formal Data Breach Notification Form now and send it to the government immediately when a data breach occurs. If you are not looking for this document, then you might be interested in our fit-for-purpose CCPA Compliance Toolkit or this free CCPA Compliance Roadmap!


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Nothing on this site shall be considered legal advice and no attorney-client relationship is established.


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